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Objectives: Millions of patients with COVID-19 were admitted to intensive care worldwide, half developed acute respiratory distress syndrome (ARDS) and received invasive mechanical ventilation (IMV), with a mortality of 50%. We analyzed how age, comorbidities and complications in patients with COVID-19 and ARDS who received IMV were associated with the risk of dying during their hospitalization. Methods: Observational, retrospective and multicenter cohort study carried out in 5 hospitals (three private and two public university hospitals) in Argentina and Chile, during the second half of 2020. Patients >18 years of age with SARS-CoV-2 infection confirmed by RT-PCR, who developed ARDS and were assisted with IMV for >48 hours, during the second half of 2020, were included. History, the most frequent comorbidities (obesity, diabetes and hypertension) and the complications of shock, acute renal failure (AKI) and pneumonia associated with mechanical ventilation (VAP), on the one hand, and the alterations of recorded clinical and laboratory parameters, were analyzed. Results: 69% were men. The incidence of comorbidities differed for different age groups. Mortality increased significantly with age (p<0.00001). Comorbidities, hypertension and diabetes, and complications of ARF and shock were significantly associated with mortality. In the multivariate analysis, only age over 60 years, ARF and shock remained associated with mortality. Conclusions: ARDS in COVID-19 is more common among the elderly. Only age >60 years, shock and ARF were associated with mortality in the multivariate analysis.